PHA5164L: Professional Skills Laboratory IV

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COPYRIGHT © 2020 UNIVERSITY of FLORIDA

PHA5164L: Professional Skills Laboratory IV Spring 2021

1 Credit Hour – A-E Grading

This course continues the development of essential skills a pharmacist is expected to perform in daily practice. The skills emphasized during this course include gathering patient data, assessing the information to identify problems, developing an individualized care plan,

implementing the care plan and monitoring and evaluating a patient. Additional skills include sterile compounding, collaborating as an interprofessional team member, safe and accurate

dispensing of medications and contributing to a culture of safety and improvement. The focus is caring for patients with gastrointestinal, renal, and endocrine diseases with problems that are simple to moderate in complexity. The patient care skills and tasks taught in this course

will prepare you to enter into hospital practice settings during your Hospital Introductory Pharmacy Practice Experience (HIPPE) and care for more complex patients in all settings.

Teaching Partnership Leader Janet Schmittgen, Pharm.D.

Email: [email protected] Office: HPNP2335 Phone: 352-273-9547 Office Hours: By appointment ONLY for private meetings, Zoom office hours TBA

See Appendix A. for Course Directory of Faculty and Staff Contact Information.

Entrustable Professional Activities This course will prepare you to perform the following activities which the public entrusts a Pharmacist to perform: Patient Care Provider Domain

1. Collect information to identify a patient’s medication-related problems and health-related needs.2. Analyze information to determine the effects of medication therapy, identify medication-related

problems, and prioritize health-related needs.3. Establish patient-centered goals and create a care plan for a patient in collaboration with the patient,

caregiver(s), and other health professionals that is evidence-based and cost-effective.4. Implement a care plan in collaboration with the patient, caregivers, and other health professionals.5. Write a note that documents the findings, recommendations, and plan from a patient encounter.

Interprofessional Team Member Domain 6. Collaborate as a member of an interprofessional team.

Population Health Promoter Domain 7. Identify patients at risk for prevalent diseases in a population.

mailto:[email protected]

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8. Minimize adverse drug events and medication errors. 9. Maximize the appropriate use of medications in a population.

Information Master Domain 11. Educate patients and professional colleagues regarding the appropriate use of medications.

Practice Manager Domain 13. Oversee the pharmacy operations for an assigned work shift. 14. Fulfill a medication order.

Course-Level Objectives

Upon completion of this course, the student will be able to: 1. Demonstrate appropriate and safe sterile compounding technique with a variety of sterile compounded

medications. 2. Accurately complete calculations related to sterile compounded medications. 3. Accurately calculate the “Beyond Use Date” for sterile compounded medications and verify compounded

Sterile Producsts. 4. Accurately verify orders in an EHR in the inpatient setting. 5. Utilize an electronic health record (EHR) to collect relevant information for a specific patient and disease

state to assess appropriateness of drug therapy. 6. Perform discharge counseling. 7. Present a succinct oral patient summary and therapeutic plan recommendations to another healthcare

provider. 8. Communicate with other healthcare professionals verbally and in the EHR. 9. Document patient care recommendations and interventions in the EHR. 10. Formulate a therapeutic plan, including nonpharmacological options, for patients with changing kidney

function, diabetes, or who is pregnant or breastfeeding. 11. Defend a therapeutic plan in writing and verbally using guidelines and primary literature for patients at

risk for or with the following disease states: a. Acute kidney injury b. Diabetes c. Diabetic Ketoacidosis d. Pregnancy/Breastfeeding e. Prevention of Pregnancy

12. Counsel a patient on a therapeutic plan. 13. Apply cost-benefit, formulary, and/or epidemiology principles to medication-related decisions. 14. Follow an evidence based disease management protocol. 15. Interpret laboratory test results. 16. Find and interpret clinical evidence in the literature for using medication during pregnancy and lactation 17. Compare and contrast contraceptive options and pregnancy testing devices, including emergency

contraception and contraception post-partum. 18. Critically evaluate a primary literature article and apply finding to patient cases. 19. Demonstrate attributes that promote a professional therapeutic relationship (e.g. empathy, cultural

competency) when communicating with a patient and/or their family. 20. During all skills laboratory simulations and activities:

a. Demonstrate altruism, integrity, trustworthiness, flexibility, and respect in all interactions. b. Display preparation, initiative, and accountability consistent with a commitment to excellence. c. Deliver patient-centered care in a manner that is legal, ethical, and compassionate. d. Recognize that one’s professionalism is constantly evaluated by others.

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Course Pre-requisites

Completion of coursework in the first three semesters of the Doctor of Pharmacy program

Course Co-requisites

PHAR 5933: Sterile Compounding PHAR 5784: Patient Care 4- GI/Renal PHAR 5785: Patient Care 5 – Endocrine/Women’s Health/Men’s Health

Course Outline Please routinely check your campus calendar and the Canvas course site for any messages about changes in the schedule including meeting dates/times, deadlines, and room changes. For locations and times of lab sessions, view Appendix B Lab Location & Sessions.

Date Recommended

Dates for Independent

Study Mod# Unit Topic

Contact Hours [hr.]a

Faculty Author

Learning Objectives Covered

Week 1 1 Module 1: Sterile Compounding I: Garbing and Aseptic Technique

1.0hr Schmittgen/Vandervoort

1,2

1/11/21 1.1 Watch: Garbing technique: Aseptic Technique Verification System Part 3 of Video (Part 3 ONLY)

1/11/21 1.2 Watch: Aseptic technique: Aseptic Technique Verification System Part 4 Video (Part 4 ONLY)

1/11/21 Watch: Mini-Bags: You Tube video found at: https://www.youtube.com/watch?v=OLvpKYkT_24 (Mini-Bag 3:46)

1/11/21 Watch: Add-vantage: You Tube video found at: https://www.youtube.com/watch?v=aFoHldOybZ8 (Add-vantage 0:41)

1/11/21 Read: Add-Vantage and Mini Bag Instructions handout

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Date Recommended




Faculty Author


1/12/21 1 Skills Lab Session 1: Garbing and Aseptic Technique • Pre-lab quiz• Practice Garbing• Practice Sterile Compounding with

Powders, Vials and Ampules• Practi-math• IV Fluid Naming

2.0hr Schmittgen/Vandervoort/Cook

Week 2 2 Module 2: Sterile Compounding II: Calculations


1, 2, 3

1/18/21 Review: Calculations material from sterile compounding course

1/18/21 Watch: Sterile Product Calculations and IV product labeling reading

0.5

1/19/21 2 Skills Lab Session 2: Sterile Compounding II: Calculations • Pre-lab Quiz• Assessment Garbing-Individual-

Faciliator assessment• Practice Calculations• Practice Sterile Compounding with

Powders, Vials and Ampules

2.0hr Schmittgen/Vandervoort/Cook

1, 2, 3

Week 3 3 Module 3: Sterile Compounding III: Beyond Use Dating and Verification


1, 2, 3

1/25/21 3.1 Watch: Beyond Use Dating 0.5

1/25/21 3.2 Review: Verification Lecture from Sterile Compounding Course

1/25/21 Review materials from Mod 1-3 and sterile compounding course

1/25/21 Read: Engel J, Lazar N. Guidelines for the Establishment of Appropriate Beyond Use Dating of Sterile Compounded Admixtures. Hosp Pharm. 2016 sep;51(8): 654-655. (Links to an external site.)Links toan external site.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030877/






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Date Recommended




Faculty Author


1/25/21 Read: FDA and ISMP Lists of Look-Alike Drug Names with Recommended Tall Man Letters (Links to an external site.)Links to an external site.

1/25/21 Read: ISMP Guidelines for Safe Preparation of Compounded Sterile Preparations (Links to an external site.)Links to an external site.

1/25/21 Read: Facts about the Official "Do Not Use" List of Abbreviations (Links to an external site.)Links to an external site.

1/26/21 3 Skills Lab Session 3: Sterile Compounding III: Beyond Use Dating and Verification • Pre-lab Quiz• Calculations Assessment-Canvas Quiz• Practice BUD/Verification

2.0hr Schmittgen/ Vandervoort/Cook

1, 2, 3

1/29/20 9:00am-11:00am

Make-Up Lab or Remediation for Calculations, Open lab for Sterile Products Practice Will be required for students who miss ANY of Modules 1-3 or who do not achieve a passing grade for any of these module assessments

Schmittgen/ Vandervoort/Cook

1,2,3

Week 4 4 Module 4: Sterile Compounding IV: Individual Assessment of IV Technique


1, 2, 3

2/01/21 Review materials from Mod 1-3 and sterile compounding course

1.0hr

2/02/21 4 Skills Lab Module 4: Sterile Compounding IV: Individual Assessment of IV Technique See Canvas site for assigned assessment time Assessment: Sterile Compounding with Powders, Vials, and Ampules-Faciliator Assessment Assessment: Verification/BUD-Canvas Quiz


1, 2, 3

Week 5 5 • Module 5: EHR Go: Order Verification 1.0hr Khoury 4, 5

2/08/21 5.1 Watch: Order Verification 0.5

https://www.ismp.org/tools/tallmanletters.pdf




http://www.ismp.org/Tools/guidelines/IVSummit/IVCGuidelines.pdf




https://www.jointcommission.org/facts_about_do_not_use_list/



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Date Recommended




Faculty Author


2/09/21 5 Skills Lab Session 5: Order Verification • Pre-lab Quiz• Verifying Orders ActivityAssessment: Individual Clinical decisionmaking during order verification CanvasQuiz

2.0hr Khoury/Schmittgen/Vandervoort/ Cook

4, 5

Week 6 6 • Module 6: Discharge Counseling 1.0 Khoury 6, 9

2/15/21 6.1 Watch: Discharge Counseling 0.5 Khoury

2/16/21 6 Skills Lab Session 6: Discharge Counseling • Pre-lab Quiz• PPCP with a patient chart in EHR GoAssessment: Individual DischargeCounseling with a Patient-FaciliatorAssessment

2.0hr Khoury/ Schmittgen/ Vandervoort/Cook

6, 9

Week 7 7 • Module 7: Patient Case Presentations 1.0 Shoulders 4, 7

2/22/21 7.1 Review: Dr. Shoulder’s presentation from Skills Lab III on Succinct Patient Case Presentations

1.0

2/23/21 7 Skills Lab Session 7: Patient Case presentations • Individually research a patient caseAssessment: Individual Patient CasePresentation-Faciliator Assessment

2.0hr Shoulders/ Schmittgen/ Vandervoort/Cook

4, 7

Week 8 8 • Module 8: Adjusting Medication forChanging Renal Function in the Hospital

1.0hr DeRemer 4, 7, 8, 9, 10, 11

3/01/21 8.1 Watch: “Renal Function Monitoring the Hospital”

1.0

Review: Content from Patient Care courses

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Date Recommended




Faculty Author


3/02/21 8 Skills Lab Session 8: Adjusting Medication for Changing Renal Function in the Hospital • Pre-lab Quiz• Cases for adjusting medication as renal

function changesAssessment: Individual Acute Renal Failure Case-Canvas Quiz

2.0hr DeRemer/ Schmittgen/ Vandervoort/Cook

4, 7, 8, 9, 10, 11

Week 9 9 • Module 9: Insulin and other injectables 1.0hr DeRemer 4, 7,8, 9, 10, 11, 12

3/08/21 9.1 Read: Slides from PC 5 0.5hr

3/08/21 Read: Assigned Portions of the ADA Guidelines

0.5hr

3/09/21 9 Skills Lab Session 9: Insulin and other injectables • Pre-lab Quiz• Insulin Adjustment Cases• Hands on with Injectables• Introduction to Carb CountingAssessment: Individual Canvas Quiz


4, 7, 8, 9, 10, 11, 12

HOMEWORK: Maintain Insulin Diary for 5 days (food, exercise, “BG”, insulin doses)

Week 10 10 • Module 10: Complications of ChronicDiabetes

1.0 hr DeRemer 4, 7, 8, 9, 10, 11, 12

3/15/21 10.1 Review: Material from PC5 0.5hr


0.5hr

3/16/21 10 Skills Lab Session 10: Diabetes Clinic 2 • Pre-lab Quiz• Debrief on Insulin Diary Assignmnet• CMR of diabetes patient focusing on

nephropathy, neuropathy and retinopathy

• A1C testsAssessment: Individual-FacilitatorAssessment


4, 7, 8, 9, 10, 11, 12

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Date Recommended




Faculty Author


Week 12 11 Module 11: DKA and Diabetes in the Hospital Setting

1.0 hr Feild 4, 7, 8, 9, 10, 11, 12

3/22/21 11.1 • Review: PC 5 material 0.5hr


0.5hr

3/23/21 11 Skills Lab Session 11: DKA and Diabetes in the Hospital Setting • Pre-lab Quiz• DKA casesAssessment: Individual Canvas Quiz

2.0hr Field/ Schmittgen/ Vandervoort/Cook

4, 7, 8, 9, 10, 11, 12

Week 11 3/29/21

MILESTONE WEEK- no skills lab meeting Dental/Pharmacy Capstone 3/31/21 on Zoom Discharge Counseling Assessment 3/30/21

Friday, 4/2/20 8:30am-10:30am

• Top 200 Drug Exam 2.0hr Schmittgen

Week 13 12 Module 12: Women’s Health TBA 10, 11, 12, 13, 14

4/06/21 12 Skills Lab Session 12: Women’s Health • Pre-lab Quiz• Triaging common women’s health

issues-Role play scenario-FacilitatorAssessment: Individual Drug Information Questions on Pregnancy and Lactation-Facilitator Graded


10, 11, 12, 13, 14

Week 14 13 Module 13: Journal Club Presentations 1.0 Patel 15

4/12/21 • Review: Patient Care 5 material

4/13/21 13 Skills Lab Session 13: Journal Club Presentations Assessment: Individual Journal Club-Facilitator Assessment

2.0hr Patel/ Schmittgen/ Vandervoort/Cook

15

Total Contact Hours in Course: 28hr

Preparation 13hr

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Date Recommended




Faculty Author


Required Textbooks/Readings There are no required textbooks for this course.

Suggested Textbooks/Readings There are no suggested textbooks for this course.

Other Required Learning Resources Top 300 Drugs Flashcards

• The flashcards are available for free through Access Pharmacy: http://accesspharmacy.mhmedical.com/qa.aspx#tab5

EHR Go

• EHR Go is an educational EHR used throughout the PharmD curriculum, including in skills lab, patient care courses and capstones. Students will be expected to purchase a subscription to this program.

• Create your EHR Go account by going to: http://ehrgo.com. Select Subscribe in the upper, right corner and enter the following Pharmacy Student Program Key: S96Y29

• Follow the on-screen instructions to create your account and apply your subscription. Refer to Canvas for more detailed information

o 2PDs are encouraged to purchase a 2 year Student Subscription o 3PDs are encouraged to purchase an Academic Year Student Subscription

Materials & Supplies Fees $49.50 per student

Percentage Range Letter Grade

92.50-100% A

89.50-92.49% A-

86.50-89.49% B+

82.50-86.49% B

http://accesspharmacy.mhmedical.com/qa.aspx#tab5

http://ehrgo.com/

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Student Evaluation & Grading Evaluation Methods and How Grades are calculated.

Table 1. Grading Scale

Rounding of grades:

Final grades in Canvas will be rounded to the 2nd decimal place. If the decimal is X.495 or higher, Canvas will round the grade to X.50. The above scale depicts this policy and grades are determined accordingly. Grade assignment is made using this policy and NO EXCEPTIONS will be made in situations where a student’s grade is “close.”

Educational Technology Use The following technology below will be used during the course and the student must have the appropriate technology and software.

1. ExamSoft™ Testing Platform 2. Canvas™ Learning Management System

For technical support, navigate to Educational Technology and IT Support Contact Information at this URL: http://curriculum.pharmacy.ufl.edu/current-students/technical-help/

Pharm.D. Course Policies The Policies in the following link apply to this course. Review the Pharm.D. Course Policies carefully, at this URL: http://curriculum.pharmacy.ufl.edu/current-students/course-policies/

79.50-82.49% B-

76.50-79.49% C+

72.50-76.49% C

69.50-72.49% C-

66.50-69.49% D+

62.50-66.49% D

59.50-62.49% D-

< 59.50% E

Assessment Item Grade Percentage

Weekly Pre-Lab Quizzes (n=10) 20% (2% for each quiz)

Weekly Skill Assessments (n=13) 65% (5% each week)

Top 200 Drug Exam 15%

Total 100%

http://curriculum.pharmacy.ufl.edu/current-students/technical-help/

http://curriculum.pharmacy.ufl.edu/current-students/technical-help/

http://curriculum.pharmacy.ufl.edu/current-students/course-policies/

http://curriculum.pharmacy.ufl.edu/current-students/course-policies/

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Course-Specific Policies The Policies in the following link apply to Skills Lab courses. Review the Skills Lab Policies carefully at this URL: http://curriculum.pharmacy.ufl.edu/current-students/course-policies/skills-lab-policies/ Weekly Pre-Lab Quizzes Weekly pre-lab quizzes will be administered online through Canvas. Quizzes will consist of knowledge related to that week’s module and covered during pre-lab preparatory activities (e.g., videos and readings). Quizzes will consist of multiple choice, true/false, or case-based questions. Weekly pre-lab quizzes will be completed at the start of each lab session. Performance on quizzes is an individual effort and collaboration is not permitted.

If you are tardy for lab, you will not be allowed to take the pre-lab quiz and will receive a zero. If you are <5 minutes tardy, you will receive a hardcopy of the quiz and have the remaining time left (from the start of quiz time) to complete the quiz.

If you have an excused absence from lab, you will be excused from taking the quiz (EX in the gradebook). No make-up quizzes will be offered

Quiz questions/answers for pre-lab quizzes in skills labs will not be released to students. This is consistent with the patient care courses. Faculty may choose to clarify difficult questions and students are encouraged to come talk to the faculty if they have questions about what they missed on a specific prelab quiz. Top 200 Drug Exam We will be using the Top 300 Drug Cards available for free to students and faculty through Access Pharmacy. A list of the drugs students are expected to know each semester will be posted on Canvas.

• Students will be expected to know the following information: o § 1PD year: 100 drugs in the fall, 100 drugs in the spring; students will need to know the brand

name, generic name, and category/indication provided by faculty for each drug o § 2PD year: ~84 drugs in the fall (Cardiovascular (48), Anti-infective (20), Respiratory (16)

Gastrointestinal (n=13) and Anti-diabetic (n=11), Men’s/Women’s Health (n=13); students will be responsible for knowing the class, common FDA label indication, MOA, Pregnancy category ONLY IF D or X (meaning patients shouldn’t use it during pregnancy), common adverse reactions (>10%) and key patient counseling points

o § 3PD year: ~38 drugs in the fall (Pain, miscelaneous), ~40 drugs in the spring (CNS); students will be responsible for knowing the class, common FDA label indication, MOA, Pregnancy category ONLY IF D or X (meaning patients shouldn’t use it during pregnancy), common adverse reactions (>10%), and key patient counseling points

• Exam is ALWAYS cumulative: any card, any info, any drug that they’ve been assigned previously is fair game

• Cut scores per course: o 1PD: 80% o 2PD: 80% o 3PD: 80%

• Question make up: each exam will be 75 questions total (50 Questions new material 25 Questions old material)

http://curriculum.pharmacy.ufl.edu/current-students/course-policies/skills-lab-policies/

http://curriculum.pharmacy.ufl.edu/current-students/course-policies/skills-lab-policies/

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• Students must obtain an 80% or better on this exam in order to pass the course. Those who do not achieve this score will retake the exam (maximum of two retakes permitted). This grade is also tracked within the Personal and Professional Development course. Please see that course syllabus for minimum performance requirements and how the results are used as milestone assessments. The score earned on the first attempt will be the score which will be used for determining the course grade. Students who fail to obtain a passing score after three attempts will fail the course. Failing to pass this course may result in a student’s progression through the curriculum being delayed.

Skills Lab Attendance Policy The maximum number of labs a student may make-up is two. Missing more than two labs significantly alters a students’ educational experience in lab and the student will fail the course. Assignment Re-grade Policy When a student doesn’t agree with a resident/APPE students’ grade on a WRITTEN assignment, the student may request a regrade

• The student must submit approval in writing to course director within 7 days of receiving the grade • Students acknowledge that the grade on the assignment could increase or decrease as a result of the

regrade • There will not be a regrade option for verbal assignments. Students should request feedback from their

grader at the conclusion of their verbal presentation (for example, patient counseling, case presentation, etc)

Course Evaluation Process Students are expected to provide feedback on the quality of instruction in this course by completing online evaluations at https://evaluations.ufl.edu. Evaluations are typically open during the last two or three weeks of the semester, but students will be given specific times when they are open. Summary results of these assessments are available to students at https://evaluations.ufl.edu/results/.

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Appendix A. Course Directory

Teaching Partnership Leader/Course Director: Janet Schmittgen, Pharm.D. Email: [email protected] Office: HPNP 2335 Phone: 352-273-9547 Office Hours: By appointment only.

Questions to Ask:

• Questions about grades • Concerns about performance • Guidance when there are performance problems (failing grades) • General questions about content

Instructional Designer Name: Julie Thomas Email: [email protected] Office: HPNP 4309 Phone: (352) 273-6284

Academic Coordinator: Name: Misti Merrill Email: [email protected] Absent Email: [email protected] Office: HPNP 4312 Phone: (352) 273-5617 Office Hours: By appointment ONLY.

Questions to Ask:

• Issues related to course policies (absences, make up exams, missed attendance) • Absence requests (Only the Academic Coordinator handles absence requests) • Questions about dates, deadlines, meeting place • Availability of handouts and other course materials • Assignment directions • Questions about grade entries gradebook (missing grades, wrong grade)




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• Assistance with ExamSoft® (Distant campus students may contact Education Coordinator for use of SofTest and assistance during exams. The Academic Coordinator is the contact person for issues related to grading and posting of ExamSoft grades.)

Other Teaching Partnership Faculty Members: Jacksonville Campus Coordinator: (Office Hours TBA on Canvas) Kelsey Cook, Pharm.D. Email: [email protected] Phone: 904-244-9876 Orlando Campus Coordinator: (Office Hours TBA on Canvas) Lisa Vandervoort, Pharm.D. Email: [email protected] Phone: 407-313-7054 John Allen, Pharm.D., BCPS, BCCCP, FCCM Email: [email protected] Jessica (Reid) Huston, Pharm.D. [email protected] 904-244-9590 Adonice Khoury, Pharm.D., BCPS Email: [email protected] Bethany Shoulders, Pharm.D. Email: [email protected] Christina DeRemer, Pharm.D., BCPS, BCACP, FASHP Email: [email protected]

Carinda Feild, Pharm.D.

Email: [email protected]

Priti Patel, Pharm.D., BCPS Email: [email protected]










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Appendix B. Lab Locations & Sessions Gainesville

• Location: Pharmacy Skills Lab • Sessions

Session 1: 8:30am-10:25am Session 2: 10:40am-12:35pm Session 3: 1:55pm-3:50pm Session 4: 4:05pm-6:00pm

Jacksonville

• Location: COP Lab • Sessions

Session 1: 8:30pm-10:25pm Session 10:40am-12:35pm

Orlando

• Location: Room 435 • Sessions

Session 1: 8:30am-10:25am Session 2: 10:40am-12:35pm Session 3: 2:00pm-3:55pm

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Appendix C. Weekly Performance Assessment Checklist Example

GATOR Way Patient Counseling Rubric

Counseling Points Each item is worth 5 points

G Identifies/introduces self as the student pharmacist.

YES NO

Explains the purpose of the counseling session YES NO

A

Identifies/confirms patient or patient’s representative.

YES NO

Makes appropriate use of the patient profile YES NO Assesses patient understanding of the reason for therapy.

YES NO

T

Verifies the name of the medication. YES NO Provides dosage/regimen for medication. YES NO Provides indication for medication. YES NO Discusses potential (major) side effects. YES NO Discusses potential warning, precautions, and interactions.

YES NO

Describes missed dose instructions. YES NO Provides number of refills. YES NO Discusses storage recommendations. YES NO Addresses any real or anticipated patient concerns.

YES NO

O

Uses open-ended questions throughout counseling session.

YES NO

Verifies patient understanding via teach back method.

YES NO

Displays effective nonverbal behaviors (eye contact and body language).

YES NO

R

Summarizes by emphasizing key points of information.

YES NO

Provides closure and opportunity for follow-up. YES NO

WAY

Student presents facts and concepts in a logical order.

Novice 1 pt

Competent 3 pts

Proficient 5 pts

Student provided accurate information. Student provided understanding and empathetic responses. Student maintained control and direction of the counseling session.

TOTAL SCORE _______ 100

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G = Greet A = Acknowledge T = Teach (using language patient will understand) O = Observe Patient Understanding R = Repeat/Review WAY = Global assessment

PHA5164L: Professional Skills Laboratory IV

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